Ⅰ型甲状成形术相关参数在喉标本和CT测量中的比较研究

Comparative study of the parameters related to type Ⅰ thyroplasty measured by laryngeal specimens and computed tomography

目的探讨Ⅰ型甲状成形术相关参数通过喉标本和螺旋CT两种不同方法测量结果是否存在差异。方法对50例喉全切除术患者的喉体标本术后立即进行测量(均为单侧),并与术前通过螺旋CT多平面重建技术所测喉体相关参数结果进行比较研究,观察两种测量结果的差异是否具有统计学意义。结果所设6个参数通过两种方法测量结果差异均无统计学意义(P值均>0.05)。应用螺旋CT和喉标本两种方法测量所设参数的结果(x±s)分别为:甲状切迹至下缘的长度为(20.7±1.7)mm和(20.6±1.7)mm;声带的长度为(17.3±1.8)mm和(17.3±1.8)mm;斜线的长度为(28.6±3.2)mm和(29.1±2.7)mm;假设水平线的长度为(26.2±2.0)mm和(26.2±2.0)mm;声带前端至假设水平线在喉内的垂直距离为(4.5±0.6)mm和(4.5±0.7)mm;声带突至假设水平线在喉内的垂直距离为(10.8±1.1)mm和(10.9±1.1)mm。填入楔形假体在喉体内前、后端的宽度分别以4～5mm和8～9mm为宜。结论通过螺旋CT的多平面重建技术对喉体进行测量是准确可信的,是Ⅰ型甲状成形术术前设计开窗和假体大小的理想方法,解决了术中设计假体大小的滞后性。

Objective To determine the consistence of the parameters related to type Ⅰ thyroplasty measured by laryngeal specimens and CT scan. Methods The related parameters of 50 laryngeal specimens （unilateral） obtained following total laryngectomy were measured postoperative immediately, and compared with those measured by spiral CT scan with multiple plain reconstructive （ MPR ） technique preoperatively. Comparative results were analyzed to evaluate the statistical significance between these two methods. Results There were no significant statistical differences among the 6 parameters between two methods （ P 〉 0. 05 ） , and the results （ x^-± s） measured by CT scan and laryngeal specimens showed that the length of the thyroid notch to the inferior thyroid border were （20. 7 ± 1.7 ）mm and （20. 6 ±1.7 ）mm;the length of the vocal cord were （ 17.3 ± 1.8 ） mm and（ 17.3 ± 1.8 ） mm; the length of the oblique line were （ 28.6 ± 3.2 ） mm and （ 29. 1 ± 2. 7 ） mm ; the length of the presumptive horizontal line were （ 26. 2 ± 2. 0 ） mm and （ 26. 2 ± 2. 0 ） mm ; the endolaryngeal vertical length of the anterior of the vocal cord to the presumptive horizontal line were （4.5±0.6） mm and（4.5 ± 0.7） mm;the endolaryngeal vertical length of the vocal process to the presumptive horizontal line were （ 10. 8 ± 1.1 ） mm and （ 10. 9 ± 1.1 ） mm, respectively. As a result, the endolaryngeal anterior and posterior width of the wedge inserted in the thyroid cartilage were 4 - 5 mm and 8 -9 mm respectively. Conclusions MPR technique of spiral CT scan is able to design the size of the window and the prosthesis of type Ⅰ thyroplasty preoperatively, which was testified to be a precise and reliable method to measure the larynx.